Apparatus for applying an elastic tie



June 28, 1960 1.. c. GRAVLEE, JR

APPARATUS FOR APPLYING AN ELASTIC TIE 2 Sheets-Sheet 1 Filed June 2, 1958 WWW/2, INVENTOR.

June 28, 1960 L. c. GRAVLEE, JR

APPARATUS FOR APPLYING AN ELASTIC PIE 2 Sheets-Sheet 2 Filed June 2, 1958 INVENTOR.

linited States Patent C APPARATUS FOR APPLYING AN ELASTIC TIE Leland C. Gravlee, Jn, Birmingham, Ala., assignor of one-third to Robert Parker, Birmingham, Ala.

Filed June 2, 1958, Ser. No. 739,210

9 Claims. (Cl. 128-303) This invention relates to means for the application of an elastic tie for the purpose of preventing the flow of fluid through a tube or the like, and it refers more particularly to apparatus for applying an elastic tie to an umbilical cord during surgery incident to birth.

A primary object of my invention is to provide apparatus wherewith an effective tie may be quickly and efficiently applied to an umbilical cord prior to severing the same incident to the surgery performed immediately after childbirth.

Accordingly, an important feature of my invention resides in the efiective application of such a tie, in a manner to completely preclude substantial bleeding, and obviate the necessity for complicated follow-up procedure presently necessary to prevent further bleeding.

The umbilical cord has been a bleeding problem since the creation of man. There have been many methods devised to tie the umbilical cord, All of them have their weaknesses as no one method is being used universally.

A series of experiments has been conducted in various hospitals involving the delivery of four hundred babies. These babies have their umbilical cords tied with cotton cord ties, the same type which has been used for the past sixty or seventy years. One hundred and eight of these four hundred had to have their cords retied in the nursery because of bleeding from the cord. One fetal death due to exangunation from the cord was recorded in this series.

Using the cotton tie technique, the baby is delivered and placed upon the abdomen of the mother; the cord is then clamped in two places and cut with the scissors between the clamps; the baby then placed on the table so that the cord can be tied in two places using six to nine knots, and the umbilical cord is out again with the scissors about two centimeters distal to the tie. When using this technique the mother is left unattended for a period of from two to four minutes. It is important that she be observed for hemorrhage and delivery of the placenta during this time.

I have devised an apparatus wherein an elastic band, in an expanded condition, is carried by a telescoping barrel. This barrel, or sleeve member, is provided with a longitudinal bore in which is placed a piston provided with a hook which projects beyond the outer portion of the sleeve. By means of this apparatus, and the trigger mechanism which will be described, the hook is used to engage the umbilical cord drawing the same within said sleeve member, while the elastic tie is at the same time disengaged over the cord, so withdrawn, constricting and tieing the same. This device will be more particularly described hereinafter.

In comparison, when my invention is used, the baby is placed on the abdomen of the mother; the cord, at the desired distance from the baby, is placed in the hook. Upon pulling the trigger or operating lever of my apparatus,:=a loop of cord is pulled inside of the sleeve and the sleeve pulled back inside its larger housing in one action. In this operation an expanded elastic ring is tripped. or of the sleeve around the cord. When the opice , crating lever or trigger is released, the automatic mechanism which -I have provided delivers the cord tied securely and prepared for the severing operation. The distal cord is then clamped; the cord is cut with the scissors and the scissors and the baby handed to the nurse. Thus, the mother is not left unattended and the entire process takes only a few seconds. The apparatus is designed to be handled with one hand. Should the occasion arise, the cord could be tied, clamped and cut with one hand. The tie which is placed upon the cord is all that is needed in this case, and it remains in place until the cord drops olf some seven to eleven days after delivery.

To this end, another important feature of my invention resides in the fact that the apparatus is so simple in design and easily operated that the most inexperienced medical student or nurse could tie the cord just as masterfully as the most skilled obstetrician.

In the experiment conducted in the development of this apparatus, another series of four hundred deliveries, using this apparatus experimentally has been done, and not a single case of bleeding was recorded.

It will be obvious that another important feature of my invention resides in the fact that I have provided an apparatus Which can easily be sterilized and subjected to the heat of an autoclave as in the case with other medical instruments.

Other and further objects of my invention, together with the features of novelty, will appear in the course of the following description.

In the accompanying drawing which form a part of the instant specification and are to be read in conjunction therewith, and in which like reference numerals are employed to identify like parts of the various views:

Fig. 1 is a perspective and isometric .view of the ap paratus of my invention including the loading mechanism.

Fig. 2 is a fragmentary sectional View of my invention taken along the lines 22 of Fig. 1 as'indicated.

Fig. 3 is an end view of my invention.

Fig. 4 is a fragmentary sectional view taken along the lines 44 of Fig. 2 in the direction indicated, to show the stop mechanism for the sleeve member.

Fig. 5 is a view partially cut away and in section of the loading member of my invention, together with its application to the apparatus.

Fig. 6 is a partial plan view of the apparatus, showing the engagement of the cord by the hook in its initial position.

Fig. 7 is a view similar to Fig. 6, showing the hook withdrawn into the apparatus with the tie in place on the cord.

Fig. 8 is a section view of the piston member, as in Fig. 2, disassembled from the apparatus.

Fig. 9 is a section view of the sleeve member of the apparatus, as in Fig. 2, disassembled from the apparatus.

Fig. 10 is a fragmentary sectional view of the housing member, as in Fig. 2, shown in the disassembled condition.

Referring more particularly to the drawings, in Figs. 1 and 2, it can be seen that the housing of my invention comprises essentially a cylindrical barrel, elongated at its forward end and curved at its rearward end, to provide a hand grip with a plurality of serrations 5 provided to enable the handle to be grasped firmly. The housing member is provided with a longitudinal bore or channel 6, of uniform diameter, extending throughout its length.

The housing member is also provided, near its forward end, with an extended slot or keyway 7, as clearly shown in Figs. 1, 2 and 10. Reciprocally disposed in the forward end of the housing member, such that it may telescope therein, is a second barrel or sleeve member 10, provided with a longitudinally extending channel or bore 11 of uniform diameter, as shown. Sleeve member 10 is provided at the lower portion of its forward end with edge flush with the outer edgic ofi'the housingmemben.

a lieyway or slot 12"which, when aligned with .the'forward end" of' theslot 7', would allow the projection of the sleeve member beyond thehousing member to provide an extending shoulder portion, 14. This shoulder portion projects from. the end: of the housingrwith' the mechanism in the forward positionjas shown in Fig. 11 I'nsoperation, thesleeve member is slidablyfift ed'into the. housingmmberasindicatede Reciprocally disposed 1n the sleeve member channel,

' asindicated; isa thirdbarrel or piston-member 16 having auniforrn channel or bore 18"as shown. In this embodi-- ment of my invention there. is wedged into the'channel of. the piston member a, plastic.- plug 21, having; its outer: end shaped to form ahookll The plug21 is provided with a pair of threaded. screw bores 23 which are aligned with screw holes: 24.- located in the. bottomv of the piston. as

shown) I 77 the.- assembled condition,. the. housing; member isprovided Witha screw pin 26. which retains a coiled spring 28, which fits the. diameter oithei bore; of-v the housing. and impinges. upon:the: rearward portionof the sleeve 'rnember 10, :as. shown in Fig; 2 ,rbiasing this memberin. a--. *forward. position. V 1

The sleeve member is similarly provided with a pin 29.- which retains a coiled spring, 31, carried by the bore 25 of. thesleeve member, impinging; uponzthe rearward sur-f face of the piston member, shown biasing the piston. memberinthe forward position. a

As assembled, the apparatus is provided with anope a; ating: lever.-.or;:triggen 32,, carrying screwsJ34a: and 34b, which: extendithrough. slotsi 7 and112, as shown, through holesf24, and are received by the, bores 23: of theplug 2l'. The. housingr'nrembei: 4 isalsoprovide'donits surface witira small slot orkeyway 8; In the: assembled con slot '32 carries. a retaining screw 36, which is5re- 35 I ceived by a thIeaded' screw bore 13, in the; sleeve member. Slot 8 is so located;imcooperationwith'slot 1 2, suchthat when: theoperatingzleverfiz isin-the forwardposition; as

. beyond the edge of sleeve memberdtl as shown At' the p same time, sleeve member 10 is restrained by screw 36' against the. forward edge of slot' 8 such that the sleeve member extends beyond housing member 4 to provide the projection 1 as shown. Slot 12 in member 10.is of suchlength that, when theoperating lever or trigger 32.. is moved rearwardly in slot 7,=screw 34b. engages the rearward end of slot 121after hook'22has been withdrawn beyond the 'forwardledge of sleevegmember 10,-

Land sleeve member lii'is, then drawnrearwardly into the housing member 4--until restrained'by' screw'36' against.

the rearwardly end of slot 8; slot 8 being of. such length that the-withdrawal of' the sleeve member 10 'isallowed until the outer edge of" such. memberis flush with the outer edge of the" housingmember. .4. e The length of slot 7 in the housing' member is greater than the le'ngthkof sloti12 'in'tl'ie sleeve member by' approximately thesainef length'fas slot 8. Sl0ti7 could-be'longer in its rejarwardly.

direction, but for operationaljpurposes this'approiimatef "lengthis sufiicient,, the purpose being, to allow the withdrawal off the sleeve member to. a. position with its-outer.

In the loaded: positiom as shown in Fig.2, the. appa V ratus' carries orrthe" projection 14' of sleeve member 15).

' an expanddelbsticflgfiSi The elastic. ring,3,8 is rvery 7 strong, and may'be'made' of'cut sections of'smallldiam eter surgical tubing. Howeven such ringmay be. madev in any suitable manner of very' strong rubber such that in its unexpanded condition the ring is very strong with a, very small diameter ontthe inside. 7

It is obvious that a problem would be encountered in loading such a'strong expanded ring 38 in position on the projection of the sleeve member. 'In the modification of my invention shown, I haveiprovidedtfor this purpose a loading cone 40. Thisfloadingconeis tapered, asshown in Figs. I and 5'; and provided with an appropriate tapered inner bore 410i suflicient size toreceive theho'ok; 22 when. the cone is. placedover the. outer edgeof. sleeve member 10. The -bore 41 isof suflicient size and enlarged at its outer'e'd'ge fora distance toprovide a shoulder 41a sized and" adapted to receive. in' atsnug fit the end of the outer projecting edg'e'14'of sleeve member 10. It can readily be seen in that the small diameter ring 38 may be threaded onto, the pointed end of the loading cone.40, as indicated in Fig, 5, andride upwardly thereon until it reaches the larger diameter end of'said'c'one. With a hand againstthe trigger mechanism 32, inj order.- to keep the sleeve memberIO in the forward position, the shoulder 41a of the loading cone may be placedover the forward edge of sleeve member 10,, pushedfirmlyvagainst said member, and the elastic ring 3.8 rolled ofi'ontothe. surface 14 ofthe sleeve member- It will be obviousthat. any number of'elastic, rings may be. carried on the length of said cone, andplaced' in position such that'the. sleeve.

' member-may be reloaded very quickly.

Referring ,more. particularlyi to. EgsLo and 7 of the drawings, wecansee how the apparatusoflmginyention. is used. inoperationr I? have. shown. therein.diagrammat.--

' ically a portion. of umbilical. cord 42ready for tieing, Withthe apparatusloaded,,with an expanded elasticringl 3.8 on the shoulder 14 oilthe sleeve member, as described, the section of the cord 42. to-be'tied is. grasped in,:the.' curvature. of hook.2-2. The trigger 320i the apparatusis then di'awnrearwardly, first withdrawing, piston plug 21. andhook.22 with the engaged cord intothe boreoii the sleevemember 10. With thecorclgflthus-withdrawn; into. the. sleeve. member 10; the trigger continues, rearward1y-,\until;..the. rearward: edge. of. slot'12. iseengaged,

whereupon the sleeve member. itself'begins .to be. withdIa-wninto thehousing member, 4. It. can be seen. that' the. outer edge of. the housing member. 4.;willjirnpinge. uponthe. elastic ring;;38 andspush said-ring oirof-projiee tion. 14- as the sleeve: member. 10 continuesv to be drawn, inthe manner indicated; Withthe portion oi the; cord. 42. drawniinto. the mechanism, as shown' thedis engaged elasticring 3,8: willcontract over thefoldsccifihez cord 42. thus withdrawn, and in'fllis. manner'firmlyatiesr said. cord to preventtheflowvof. any fluid therethrough, When. the triggerisreleased, the hook 22f thenprojects'tv againefromv the 'housingand can. be disengaged fromfth e loop of the cord-42 which has. beentiedc In theflcaserof an umbilical cord, the distal cord is then clamped Witlilla;

suIgiCaLinstrumentandZ the: cord is cut withs'cis'sorslbetween'the clamped portionand thetiedportion, andzth'ei baby, severedfromhis cohnectionWith. thetmothen. Thus; the mother. isnoti l'eftzun'attended: and takes'only a'few seconds-.1 2' 1 V 7 In the drawings shown, Figs; 4, '6 and. 7 arerdiagra-mmatic, for the purpose-ofvshowingthe operation ofcthex mechanism' Fig; 2has been modifiedl bythe broken.

lines to. show the alternate positiomof the? trigger" and piston mechanism. as the apparatusais. operated: 7

Considering the apparatus. as a series-oftelescopingi barrels, constructed in the manner indicated,.inthe:"deJ- livery; of a baby, the use-oi this apparatusiis quite efiicient and simple; The. baby; is' simplyplace'd on the abdomen of the mother; the 'cord', at ,the: desired distance.

'from. the'baby', is placed inzthe' hoole Uporr'pullingthel trigger. a; loop of cord pulled: inside: the smallerbarrel, orv sleeve. member, and the smaller barrel'is' pulled back insidetheilar'ger barrel or housing member'in'one action-J This action. resultsin: ftrippingf the. rubber tubingonI the entire: process elastic band off around the cord. The trigger is released and the automatic mechanism delivers the cord tied securely out of the barrel. The distal cord is clamped; the cord is then cut with the scissors and the scissors and the baby are both handed to the nurse. This is a great improvement over the old method where the mother must be left unattended while the surgeon is making the ties in the cord by hand.

There are certain advantages to this apparatus whichwill be at once obvious. It ties the cord securely so that no bleeding occurs. The tieing operation does not divert the obstetricians attention from the mother for more than a few seconds. The pistol type grip and trigger facilitate handling of this instrument, because everyone is familiar with the general contour and workings of a pistol. It does not require a highly trained person to tie the cord very securely. The time is cut to a minimum. The instrument, with the hollow bore extending throughout its members can be sterilized with any of the conventional methods. The mechanism of the apparatus is very simple and one instrument should last for a life time. The cost of rubber tubing, or the elastic tie as we described it, is very small. The gun can be loaded when needed by any maid or nurses aide. This apparatus should be ideal for a physician who delivers a baby in the home, or sends them home shortly after delivery. Under these circumstances the baby and the cord will not be under the scrutiny of trained medical personnel. The rubber tubing, or elastic tie, can be allowed to remain in place until the cord drops off from seven to eleven days after delivery. This also obliterates the necessity of removing the tie or instrument severals hours after delivery.

It can also readily be seen that this apparatus for making a tie could be applied to other operations where a cord must be tied in such manner. Its unlimited application will be obvious from its method of operation.

From the foregoing, it will be seen that the invention is well adapted to attain the ends and objects hereinbefore set forth together with other advantages which are obvious and which are inherent to the invention.

It will be understood that certain features and subcombinations are of utility and may be employed without reference to other features and subcombinations. This is contemplated by and is within the scope of the claims.

Inasmuch as many possible embodiments of the invention may be made without departing from the scope thereof, it is to be understood that all matter herein set forth or shown in the accompanying drawings is to be interpreted as illustrative and not in a limiting sense.

Having thus described my invention, I claim:

1. An apparatus for applying an elastic tie of the character described comprising, a housing member, a sleeve member and a piston member, each provided with a longitudinally extending channel, said sleeve member reciprocally telescoping into the channel of the housing member and biased forwardly thereof with means limiting the forward projection of the sleeve to provide a projection thereof adapted to receive an expanded elastic ring, said piston member reciprocally telescoping into the channel of the sleeve member and biased forwardly thereof to provide a projection of the piston extending from the sleeve adapted to receive and hold a cord to be tied, operating means for said members including a lever engaging said sleeve member and piston member adapted to first withdraw the piston and cord into the sleeve and then Withdraw said sleeve into the housing member, thereby to displace the elastic ring onto said cord constricting and tieing the same.

2. Apparatus as in claim 1, including in combination therewith means for loading an expanded elastic ring onto the projection of the sleeve member comprising a loading member having a bore adapted to receive the projection of said piston, a flared shoulder at the opening of said bore adapted to fit the end of the projection of the sleeve member and encompass a portion of the same, said loading member having sides'converging to the opposite end thereof adapted to receive a contracted elastic ring, whereby said ring may be rolled into expanded position on said sleeve projection.

3. Apparatus as in claim 1, wherein said operating means comprises a pair of juxtaposed longitudinal keyways in said housing member and sleeve member, said keyway in the sleeve member being of lesser length than the keyway of the housing member and aligned with the keyway of said member at its forward end to cause said projection of the sleeve member beyond the housing, a key extending through said ways aflixed at its inner end to the piston member such that in its extreme forward position the projection of the piston extends forwardly from the sleeve, said key adapted when moved rearwardly in said way to first withdraw the piston projection into the sleeve and impinging upon the rearward end of the way in the sleeve then to withdraw the sleeve into said housing member.

4. Apparatus as in claim 1, wherein said means for limiting the forward projection of the sleeve member comprises a keyway in said housing member and a key.

extending through said way alfixed at its inner end to the sleeve member adapted to limit the forwardly biased movement of the sleeve member to provide a limited projection thereof when said key impinges against the forward edge of said way.

5. Apparatus for applying an elastic tie of the character described comprising, a housing member, a sleeve memher and a piston member, each provided with a longitudinally. extending channel, said sleeve member mounted to reciprocate and telescope into the channel of the housing member, said piston member mounted to reciprocate and telescope into the channel of the sleeve member and provided with an extension at its forward end having a configuration adapted to receive and hold a cord to be tied, means biasing said sleeve member and piston member forwardly in their respective channels to provide a projection of the sleeve member from the housing adapted to receive an expanded elastic ring and the projection of said piston extension beyond the sleeve in the forward position, restraining means limiting the projection of the sleeve member adapted to receive said ring, operating .means for said members including a pair of juxtaposed longitudinal keyways in said housing member and sleeve member, said keyway in the sleeve member being of lesser length than the keway of the housing member, a key extending through said ways afiixed at its inner end to the piston member such that in its forward position in the keyways against the forward ends thereof said piston extension projects forwardly from the sleeve member with said sleeve member projecting forwardly from the housing member, said key adapted when moved rearwardly in said ways to first withdraw the piston extension with a cord to be tied into the sleeve and impinging upon the rearward end of the way in the sleeve member to withdraw the sleeve projection into the housing member, thereby'to displace the elastic ring onto said cord constricting and tieing the same.

6. Apparatus as in claim 5, including in combination therewith means for loading an expanded elastic ring onto the projection of the sleeve member comprising a loading member having a bore adapted to receive the projection of said piston extension, a flared shoulder at the opening of said bore adapted to fit the end of the projection of the sleeve member and encompass a portion of the same, said loading member having sides converging to the opposite end thereof adapted to receive a contracted elastic ring, whereby said ring may be rolled into expanded position on said sleeve projection.

7. Apparatus as in claim 5, wherein said means biasing the sleeve member and piston member respectively in their forward position comprises a spring in the channel of said housing member in contact with the rearward end 0i the'QSIeeVe'membeFthe sleeve member for 7 her has a configuration of its rearward end' to" foi m a ration thereof extending outwardly andiforwa-rci'from' saifi wardly; 'and'zispring inthe channel ofthe sle'eve member handle and said key is provided with and operating hanin'i conta'cti the rearward end of. the piston member dle extendinga from the housing member. firging the pisfon member forwardly. r

8. Apparatus as in claim 5'; wherein the: extension of 5 Refemmces Citefi in SP? said: piston memb er comprises a' plug havinga coma-gm UNITED STATES P N 302,509 Mauthner Jilly- 22, 1884- memberitofmm athook" 2,619,964 Thaete Dec, 2, 1 952 9; Apparatus-as tin claim 5; vwherein the hdusin g meminn. 

